What is it’s history?

Pneumonia has a long history, going all the way back to the ancient and primitive worlds. It was described for the medical community by Hippocrates around 400 B.C. Still, little was known about it until the end of the 19th century, at which time it surpassed tuberculosis as the most common cause of death.

This inspired Dr. Henry Osler, in the 1901 edition of his “Principles and Practice of Medicine,” to quip: “The most widespread and fatal of all infectious diseases, pneumonia, is now the “Captain of the Men and Death,” to use the phrase applied by John Bunyon to consumption.”1, Reynolds

Is it still deadly?

It’s still a serious disease, although it has been reduced to the 8th leading cause of death. About a million people are diagnosed with it each year, and another million require hospitalization. So, it must be taken seriously. However, thanks to improved medical wisdom, along with antibiotics and technology, it’s easier to diagnose and treat. Today, most people diagnosed with it recover fully.2, Egan

What is it?

It’s an infection of the air exchange units in your lungs, mainly the respiratory bronchioles and alveoli. An immune response causes this area to become inflamed. White blood cells (WBCs) are sent to the area of infection. The purpose of this response is to trap, kill, and remove the pathogens. As the disease progresses, the accumulation of WBCs cause pus to fill these areas, making them poor air exchange units. This means they become poor at allowing blood to cross into the bloodstream, resulting in a drop in blood oxygen levels. 3-5

Early recognition of the signs and symptoms, and aggressive treatment, can prevent pneumonia from progressing this far.

What are the symptoms and signs of pneumonia?

Bacterial pneumonia usually starts out as an upper airway infection, such as a typical cold or influenza. Coughing is a common symptom. You may feel pain when you inhale, or when you take in a deep breath or cough. Infections often cause a fever, chills, shaking, weakness, and fatigue. You may feel winded with exertion. You may feel winded (dyspnea) at rest, especially if your oxygen levels are low. Your cough may be productive with colorful sputum, such as yellow, tan, brown, green, or red. Bacteria is known for causing colorful sputum.

If you have COPD, it’s important for you to be vigilant to these symptoms, and call your doctor as soon as you observe them.

What causes it?

Most cases of pneumonia are community acquired. When children get pneumonia, it’s usually caused by viruses. When adults get pneumonia, it’s usually caused by a bacteria, so that’s what we will focus on here considering COPD is typically diagnosed after the age of 40. 4

About 80% of community-acquired pneumonia is caused by a bacteria called Streptococcus Pneumoniae (Pneumococcus). (2-3) It is normally present in the nose and throat of about 60% of people. It may also be inhaled when others infected with it cough or sneeze. 4

Your immune system is usually very effective at keeping it clear of your lower airway. However, sometimes it gets the better of your immune system and causes pneumonia. This is most likely to occur during a viral infections (colds), in the elderly, or in people with chronic diseases like COPD. 3, 4, 6

Why are COPD patients vulnerable to pneumonia?

Anyone can get pneumonia, although people with chronic bronchitis are increasingly vulnerable to it. This is because years of inhaling chemicals in cigarette smoke have caused damage to airways resulting in an increase in goblet cells and a loss of cilia.

Goblet cells are mucus producing cells. They are needed to produce sputum, which traps bacteria. Cilia are microscopic, hair-like structures that rapidly move back and forth to move mucus (escalator fashion) to the back of your throat to be swallowed. The germs are then killed by stomach juices.

After years of inhaling chemicals in cigarette smoke, the number of goblet cells are abnormally elevated, making it so your lungs produce excessive mucus. Likewise, cilia are destroyed, reducing your body’s ability to bring mucus to your upper airway. The combination of these factors causes mucus to build up in your lungs. This warm, humid environment acts as a breeding ground for bacteria (mainly pneumococcus) that cause pneumonia.

How is it diagnosed?

It can sometimes be diagnosed simply by your description of symptoms and signs you describe. Infections cause white blood cells (WBCs) to increase, and this can be confirmed by a blood test. A sputum sample can be sent to a lab to confirm that a bacteria is present. As noted above, pus or fluid often fill air alveoli. This is called consolidation. It can show up on an x-ray and cat scan.

Bacterial pneumonia is usually isolated to one lobe or region of your lungs. It can be heard by using a stethoscope (auscultation) and produces a sound called crackles during inspiration. Crackles sound like when you pull velcro apart. Since bacterial pneumonia is usually isolated to one lobe (lobar pneumonia) crackles are only heard over one lobe. You can usually hear pneumonia before it shows up on x-ray.

How is it treated?

Bacterial pneumonia is very responsive to antibiotics. If caught in the early stages, it can be treated at home. However, it can sometimes get bad enough to cause a COPD flare-up that requires a hospital admission.

Other treatments may also be indicated to treat complications of pneumonia. For instance, low oxygen levels may be treated with supplemental oxygen. COPD flare-ups may be treated with systemic steroids and albuterol breathing treatments.

Can it be prevented?

The best way to prevent pneumonia is to stay as active as you can. It’s important that you develop effective coughing strategies to help you bring up secretions. You should also make sure to get the Pneumococcal vaccine, which is shown to reduce your risk for getting pneumonia.

The CDC recommends that anyone who smokes cigarettes, is over the age of 65, or has a chronic heart or lung disease, should get this vaccine every 6-12 months.7-8

Seek help when you need it!

As you can see, people with COPD are at an increased risk for developing pneumonia. When you observe symptoms and signs of COPD that fail to respond to your typical treatment regimen, or you observe any of the above symptoms of pneumonia, you should seek immediate medical attention.

The earlier you seek help, the easier it is for physicians to fix you, and the more likely you can be treated on an outpatient basis. However, sometimes you may require a hospital admission so doctors can work their magic to help you overcome your pneumonia/COPD flare-up.

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Reynolds, Arthur, R., "Pneumonia: The New Captain of the Men and Death," February 28, 1903, Journal of the American Medical Association," XL(9):583-586, http://jamanetwork.com/journals/jama/article-abstract/854678, accessed 1/2/16